This interactive US map shows the percentage of COVID-19 nucleic antigen amplification tests that were positive during the week ending on 3/1/25. In Region 1, which includes Massachusetts, the percentage of positive tests was 3.2%, a 0.1% decline from the previous week. Click here to view the percentage of positive COVID-19 tests in each region during this time period. Credit: Centers for Disease Control and Prevention.

health disparities

COVID-19 in 2025: ‘A Constant Threat, but a Manageable One’

As we enter the sixth year of life with COVID-19, SPH faculty members Davidson Hamer, Laura White, Jonathan Levy, Patricia Fabian, Brooke Nichols, Matt Motta, Timothy Callaghan, and Jennifer Weuve discuss how they expect the virus to evolve, and how we can apply lessons learned to mitigate future suffering from COVID-19 and other infectious disease threats.

Five years after the World Health Organization declared COVID-19 a pandemic, the virus has largely receded from public conversation and daily routines—and when it does arise, it’s often referenced in the past tense. 

By certain metrics, the darkest days of the pandemic are indeed behind us. Daily reported deaths in the United States have plummeted from staggering highs of 5,000+ reported deaths per day in 2021 to around 280 reported deaths per day at the end of February of this year. Multiple vaccines are widely available, as are antiviral treatments. Social distancing is now a distant memory. 

But the pandemic continues to profoundly reshape society. Millions of lives have been forever altered by the loss of loved ones, multiple illnesses, economic strain, and poor mental health. Furthermore, excess death estimates suggest that many COVID-19-attributed deaths are being overlooked. While most epidemiologists and other public health experts generally agree that COVID-19 is now endemic—meaning that the virus is continuing to circulate, but at more predictable levels that are consistent with other common viral diseases—they also emphasize that it remains a serious public health concern.

The challenge ahead

“The virus is still capable of evolving and it’s going to remain a constant threat. But because so many people have had at least one infection and or multiple doses of vaccines, I think the severity of infection will generally remain relatively low,” says Davidson Hamer, professor of global health and medicine at SPH and the Chobanian & Avedisian School of Medicine, and a core director at BU’s Center on Emerging Infectious Diseases (CEID). “That said, the challenge is that people with advanced age, underlying medical comorbidities, and who are immunocompromised, are still at risk of becoming quite ill from this virus and potentially dying.”

Beyond individual risk, the pandemic exposed and exacerbated deep-rooted structural inequities within this nation, along the lines of race, employment, income, gender, age, and region. Since 2020, the school community has studied and highlighted the broader lessons this global crisis has taught us—including the need for greater investment in public health infrastructure; clear, consistent, and tailored health communication and messaging; and a rebuilding of trust in science, largely fractured by an ever-increasing partisan divide. As we continue to navigate COVID-19 in the United States—along with the growing threats of avian flu, influenza, the once-eradicated measles, and a number of other global infectious diseases—the question today is, how do we use this data to inform actionable change in the future? 

Unraveling DEI work

One priority should be to address the underlying disparities that lead to worse health outcomes among lower-income populations and communities of color, says Jonathan Levy, chair and professor of environmental health.

“The same populations had higher exposure risks in the workplace, higher transmission risks at home, worse access to healthcare, and lower vaccination rates during key points in the pandemic,” he says. “Unfortunately, I don’t think we took the steps necessary to address these disparities, and I am very worried that any attempt to describe patterns of exposure and health risk across the population—let alone to address disparities—will be cast as ‘DEI [diversity, equity & inclusion]’ work.”

This work is already unraveling under the second Trump administration. On his first day back in office, President Trump signed an executive order to terminate all federally funded programs related to DEI. And on Friday, March 7, the National Institutes of Health (NIH) complied with these efforts and rescinded millions of dollars in research grants to scientists studying issues related to DEI and transgender health. These most recent actions directly defy court orders—including one from the day prior—that blocked the administration from restricting such funding.

“It is the job of public health to explain who is at highest risk and to propose strategies to reduce that risk, and when the empirical evidence shows that exposures and risks are patterned by race, ethnicity, gender, or other markers of identity, we need to be able to present that evidence clearly,” Levy says. In 2022, for example, he and a team of SPH faculty, staff, and students in the departments of Environmental Health and Biostatistics developed an analysis for the Boston Globe that examined disproportionate COVID mortality rates in Massachusetts.

“Our analysis showed much higher COVID death rates among Black and Latino individuals in the first two years of the pandemic, but a different pattern after the Omicron wave where White individuals had higher COVID death rates,” Levy says. “We need to be able to tell those stories and use them to inform smart interventions.”

Modeling for COVID-19, flu, measles

Federal funding has fueled many critical COVID-related research projects that launched during the height of the pandemic. Laura White, professor of biostatistics, and Kayoko Shioda, assistant professor of global health, who also co-lead the Data Science & Surveillance research core at CEID, are the lead BU collaborators of a Northeastern University-led innovation center that launched in 2022 to help detect and prepare the public for future outbreaks. The center is part of a $17.5-million, multi-institution initiative funded by the Center for Forecasting and Outbreak Analytics, which is housed within the Centers for Disease Control and Prevention (CDC).

“This center has invested in funding 13 centers around the country that bring together public health officials, researchers and industry partners to build our national infrastructure to be better poised to respond to emerging disease threats,” she says. “This includes building data systems and analytic tools to allow us to detect, monitor, predict and communicate with the public about outbreaks.” 

The team has had no shortage of projects since the initiative launched, providing modeling efforts and informing the response to a measles outbreak at a migrant shelter in Chicago last summer, as well as ongoing monitoring and modeling of the H5N1 avian flu, and now developing tools to predict and respond to the ongoing measles outbreak in Texas.

“Infectious diseases continue to emerge and there is no reason to think that will change or slow down,” White says. “We learn a lot from each of these outbreaks, and with appropriate investment, have opportunities to do research and build infrastructure that will better prepare us for future and ongoing threats.”

Rapid antigen testing

It’s also important to utilize the tools we already have at our disposal to help prevent outbreaks, and rapid antigen tests proved to be one of these essential tools throughout the pandemic, as the tests enabled people to quickly and easily identify positive COVID cases at home. The tests were especially valuable in low- and middle-income countries (LMICs), where vaccines and the gold-standard polymerase chain reaction (PCR) tests were limited. In 2022, Brooke Nichols, associate professor of global health, co-led a WHO report and modeling consortium that examined the role of rapid diagnostic testing in LMICs. She continues to study emerging diseases, and says the progression of H5N1 remains a top concern. 

“A robust surveillance system is required to make sure we can respond in time before an outbreak occurs—and also ensures that we have the diagnostics required to be able to rapidly characterize what is circulating,” Nichols says. “There is a huge diagnostic gap globally, particularly for high-priority pathogens. Investing in the appropriate diagnostics now is critical so we are prepared for any future outbreaks.”

School transmission

Understanding and monitoring COVID transmission in schools remains critical for preventing outbreaks. Schools are naturally common settings for disease transmission due to close contact, shared space, and poor ventilation, and research shows that in-person schooling contributed substantially to household COVID transmission after states began lifting stay-at-home measures in the fall of 2020. As part of its COVID Preparedness Plan, the Biden administration launched a national campaign in 2022 to improve air quality in buildings, but much more needs to be done today to educate the public about clean air, says Patricia Fabian, associate professor of environmental health.

“While the pandemic elevated the importance of clean indoor air with the public, over time that interest and investment in solutions has waned,” Fabian says. “Half of schools do not have an indoor air quality management plan and even fewer monitor indoor air quality.” Yet, 41 percent of schools lack adequate HVAC systems.

Emerging concerns about gas stoves, mold in building materials, and wildfire smoke indoors present scientists with new opportunities to push for sustainable ventilation and other solutions to make residential and commercial buildings resilient to new indoor air challenges, Fabian says.

“Like this StoryMap shows, the linkages between indoor environmental quality on learning and health in schools are clear, but there is still a disconnect in people’s minds between the impact the building and its heating, air conditioning, ventilation and filtration systems can have on indoor air and thermal comfort,” says Fabian.

Mitigating vaccine hesitancy

In the Texas measles outbreak, many community members are concerned that the state is not doing enough to prevent in-school transmission. And as cases continue to increase, medical and public health experts are worried that Health and Human Services Secretary Robert F. Kennedy, Jr.’s response to the deadly outbreak—the largest measles outbreak in the US in decades—has been inadequate and confusing. Rather than explicitly recommend the measles, mumps and rubella (MMR) vaccine, a proven way to protect against measles, Kennedy, Jr. suggested parents consider vaccination, called the decision to vaccinate a “personal choice,” and touted the benefits of treatment methods such as vitamin A and cod liver oil. 

“The MMR vaccine remains the most effective way to protect the public against the measles,” says Timothy Callaghan, associate professor of health law, policy & management (HLPM). Data does suggest that Vitamin A can protect against complications from measles—but only among people who are deficient in Vitamin A, he says. “Highlighting Vitamin A as a treatment could lead to it being seen as a viable alternative to vaccination among the vaccine hesitant, even as it is not a viable path to stop the measles outbreak.”

Callaghan and Matt Motta, assistant professor of HLPM, recently launched the Politics and Health Lab, an SPH initiative that aims to monitor and depolarize the growing politicization of public health, including partisan attitudes and beliefs towards vaccination. Through the lab’s State Vaccine Policy Project, Callaghan and Motta are currently tracking all of the anti-vaccine bills being introduced by state legislatures; in 2023, states introduced more anti-vaccine bills than pro-vaccine bills, and the legislation was largely divided by party lines, with Republican lawmakers introducing the majority of anti-vaccine bills. Kennedy, who has a long history of embracing anti-vaccine positions, recently pledged to investigate the childhood vaccine schedule after promising not to change it.

“Unfortunately, there’s no single blueprint for rebutting Kennedy’s misleading Vitamin A claims,” says Motta. What public health experts can do, he says, is “meet people where they are.

“Health communicators should highlight the very real dangers of measles infection, and then draw a distinction between pre-infection prevention through vaccination, and post-infection treatment,” Motta says. “I think the most effective approach here is to try to appeal to parents’ concerns about their children’s safety and well-being by portraying measles as a serious public health risk that can be mitigated through vaccination.”  

This approach is one that Jennifer Weuve embraces, as well, to impart the safety and efficacy of vaccines. A professor of epidemiology, Weuve co-led SPH’s Epidemiology COVID Response Corps at the height of the pandemic, and has studied COVID’s effect on aging and dementia risk. 

“Epidemiologists—including me—strive to advance human health with strategic use of statistics and logic,” Weuve says. “But the reality is that statistics and logic are not the first things most people’s brains use in responding to a health claim. We are wired for stories and knowing how some health claim affects us and affects our loved ones.”

To anyone who is concerned about vaccines, she says, “I would say this: think about your family and friends—all the people you love, including those who are no longer here. How many had the measles? How many had smallpox? How many had cervical cancer in the past 10 years? How many died from influenza or COVID-19? If none of your loved ones experienced these conditions or deaths, you can thank vaccines, all of the folks in your community who were vaccinated, and even all of the vaccination campaigns throughout history that brought some diseases near to extinction.”

Weuve also notes that the level of protection that a vaccine provides depends on the vaccine itself and the disease it’s intended to prevent—and that safety measures such as face masks can provide an additional layer of protection against airborne diseases, including COVID-19, for those who wish to use them.

“You can think of vaccines as powerful tools that can help you and your loved ones—no matter what your age—live a life that is freer from the awfulness of the diseases vaccines prevent. COVID-19 affects lung health, heart health, blood coagulation, fertility, and other functions of our bodies. The vaccines do not have these effects.”